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Application for One-on-One Coaching

Answer a few questions so we understand how to help you. Email us at: [email protected]

How did you hear about us?

Phone Number

First Name

Address

City

Country

Zip Code

Do you own the property?

Whose name is on the deed?

Best day and time to contact you? (Please provide 3 options)

Property Information

Do you have a pool? (Need to take water safety class)

Do you have a septic tank?

Do you live in the house?

What are your plans for moving

Do you have caregiving experience? What do you do for a living?

What have you done so far in the process?

Where do you feel stuck?

Who are the parties that will own the assisted living?

What are their names?

What are their email/s and phone number/s?

What's the percentage of the ownership for each owner?

Do you have an LLC yet?

Do you have an NPI (National Provider Number) yet?

Have you applied for Medicaid in the past? Any issues with Medicaid?

Any background issues for anyone who will be involved in the business? Must be able to pass a level two background.

Have you completed the core training or the 12 hour AFCH class?

Who will be the administrator?

What is the budget for your facility licensing project?

Do you know you will need a fire alarm, fire sprinkler, generator, reserve gas & money reserve for the proof of ability to operate?

What services are you looking for?

Have you received the zoning approval yet?

Is there anything else you want to tell us?